Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Primers

Supreme Court Ruling on Medicaid Expansion Led to Coverage Gap

by Vera Gruessner

A Supreme Court ruling in 2012 determined that the Patient Protection and Affordable Care Act is Constitutional while Medicaid expansion is optional for individual states to pursue. This led more than two dozen states to postpone Medicaid...

Merger Suit Led Aetna to Drop out of Health Insurance Exchanges

by Vera Gruessner

The national health payer Aetna may have chosen to reduce its participation in the Affordable Care Act’s health insurance exchanges due to the Department of Justice’s decision to pursue a lawsuit against the merger between Aetna and...

VT Agency Wrongly Allotted $13M for Health Insurance Marketplace

by Vera Gruessner

The Department of Vermont Health Access went against federal laws when it failed to allocate funds to establishment grants in order to create a public health insurance marketplace, the Office of the Inspector General (OIG) found in a new report....

Presidential Election Brings Two Opposing Healthcare Policy Proposals

by Vera Gruessner

With the Presidential election heating up and the debate season upon us, last week The Commonwealth Fund detailed the stark differences seen between the two presidential candidates healthcare policy proposals in a new report. The research comes...

Medicare Advantage Premiums Drop 13% Due to Affordable Care Act

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced in a press release late last week that the average Medicare Advantage monthly premium will be 13 percent lower in 2017 than before the Patient Protection and Affordable Care Act...

Comprehensive Primary Care Plus Program Selects Anthem BCBS

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has selected Anthem Blue Cross and Blue Shield in Colorado as a participant for their Comprehensive Primary Care Plus (CPC+) initiative, according to a company press release. The Comprehensive...

New England, Great Lakes Perform Best at HEDIS Quality Measures

by Vera Gruessner

More than 90 percent of commercial health insurance companies throughout the country adhere to HEDIS quality measures in order to show consumers and surveillance agencies their overall performance with regard to prevention, treatment, and patient...

Health Insurance Acquisitions Impede Competition in 24 States

by Vera Gruessner

The American Medical Association (AMA) announced today in a press release the results of a new study show that the health insurance acquisitions between Anthem-Cigna and Aetna-Humana would obstruct competition in the health insurance market throughout...

CMS Bundled Payment Models Cut $864 for Orthopedic Care Episode

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a report encompassing the second annual evaluation of the Bundled Payments for Care Improvement initiative, according to The CMS Blog. This summer, a new proposal was...

Why Aetna, Humana Argue in Favor of Health Insurance Merger

by Vera Gruessner

On July 21, the Department of Justice (DOJ) announced during a press conference that they would be filing a lawsuit against two health insurance mergers between Aetna-Humana and Cigna-Anthem. The DOJ claimed that these health insurance mergers...

Lawmakers Push for Public Option on Health Insurance Exchanges

by Vera Gruessner

A total of five senators and multiple organizations are looking to create a public option for healthcare coverage to be available among all Americans purchasing insurance through the Affordable Care Act’s health insurance exchanges. Senators...

Healthcare Bundled Payments Hinder Skilled Nursing Facilities

by Vera Gruessner

How are skilled nursing facilities and other post-acute care centers handling the transition to a value-based care reimbursement environment? Fitch Ratings stated in a press release that many post-acute care providers are finding it difficult...

CMS Accountable Health Communities Model Stresses Social Needs

by Vera Gruessner

This past January, the Centers for Medicare & Medicaid Services (CMS) announced a new funding opportunity for a program called the Accountable Health Communities (AHC) Model, which focuses solely on the social needs of Medicare and Medicaid...

AMA Urges NY Regulators to Reject Health Insurance Mergers

by Vera Gruessner

The Anthem-Cigna and Aetna-Humana health insurance mergers are facing more and more scrutiny throughout the medical industry and among federal officials. While the US Department of Justice filed a lawsuit against these health insurance mergers,...

Rising Specialty Drug Prices Plague CMS, Medicare Beneficiaries

by Vera Gruessner

Even though the Obama administration’s Patient Protection and Affordable Care Act assisted Medicare beneficiaries by attempting to end a drug coverage gap called the “doughnut hole” through plan payments and drug manufacturer...

Payer Concentration Challenges Health Insurance Exchanges

by Vera Gruessner

More and more research is pointing at the fact that consumers on the health insurance exchanges are being left with fewer health plan issuers. Part of this may be due to health payers such as UnitedHealthcare or Aetna leaving a large percentage...

Affordable Care Act Marketplace Consumers Face Fewer Choices

by Vera Gruessner

A hefty number of health insurance companies have been dropping out of the Affordable Care Act’s state exchanges in recent months including Humana, Aetna, and UnitedHealthcare. These actions would leave fewer health plans to choose from...

7% of Counties Retain One Payer on Health Insurance Exchanges

by Vera Gruessner

With more health payers such as UnitedHealthcare, Humana, and Aetna dropping out of a number of state health insurance exchanges, it is useful to analyze the differences of healthcare coverage between different regions and states around the country....

Medicare Shared Savings Program Saved $466 Million in 2015

by Vera Gruessner

The Centers for Medicare and Medicaid Services (CMS) announced last week the quality and financial results of the 2015 Medicare accountable care organizations. According to a press release from CMS, accountable care organizations operating under...

New York, California Enact Rulings Against Surprise Medical Bills

by Vera Gruessner

Healthcare payers may find that they may no longer have to pass on extraneous costs to their consumers when out-of-network providers send more costly claims their way. New legislation in states like New York and California may soon put an end...

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